Stents open clogged arteries of 1M Americans annually

Aug. 7, 2013
|

Steven E. Nissen, cardiologist / Scott Saltzman, Bloomberg News

by Liz Szabo, USA TODAY

by Liz Szabo, USA TODAY

Former president George W. Bush should recover and be able to lead a normal, active life after leaving the hospital, where doctors placed a stent Tuesday to open clogged arteries, medical experts say.

In a statement, spokesman Freddy Ford said Bush underwent the procedure after a routine physical, although he had not been experiencing symptoms such as chest pain.

Stents are placed to reduce the risk of heart attack. They are common devices, placed in about 1 million Americans a year, says John McPherson, a cardiogist at Vanderbilt University Medical Center in Nashville.

Stents act like scaffolds to prop open blocked arteries in the heart and allow blood to flow normally, says John Harold, president of the American College of Cardiology and a clinical professor of medicine at the David Geffen School of Medicine at UCLA.

Neither Harold nor McPherson has treated Bush.

Placing stents is a much less invasive procedure than open heart surgery. Stents are placed by interventional cardiologists, who make small incisions in the wrist or groin, then thread a catheter through a major artery up to the aorta, Harold says. Doctors use a balloon to open up a blocked artery, then unroll the stent, which is left in place. Many stents also release drugs, some in continuous doses, which help prevent the artery from getting clogged up again.

Patients typically will take blood thinners, such as aspirin and clopidogrel, which help prevent further clots, McPherson says. Doctors will also test Bush's cholesterol to see if he needs to take statins, which help reduce cholesterol and which, like clopidogrel and low-dose aspirin, would be taken for the rest of his life.

At 67, Bush is at an age that puts him at higher risk of a heart attack, McPherson says.

Yet Bush, an avid jogger and bicyclist, is exceptionally fit for a man of any age. Since leaving office, Bush has hosted 100-kilometer bicycle rides for wounded troops, the most recent in May near Waco.

But even a healthy lifestyle won't prevent all heart disease, McPherson says. And while the stent indicates that Bush has an increased risk of heart attack, managing his risk factors, such as his cholesterol and blood pressure, will help keep him healthy.

The Cleveland Clinic's Steven Nissen questions whether Bush will really benefit from a stent. Doctors typically place stents only in patients who are having heart attacks or significant symptoms, such as chest pain, says Nissen, chairman of cardiovascular medicine at the Cleveland Clinic. Stents can help keep blood flowing and reduce the risk of a heart attack in these patients.

But stents haven't been shown to reduce the risk of heart attacks in patients without symptoms, says James Beckerman, a cardiologist at the Providence Heart and Vascular Institute in Portland, Ore. Stents also don't help these patients live longer. And Nissen notes that stents themselves can become clogged up, causing greater problems.

Bush spokesman Ford said Tuesday that, while Bush didn't experience those symptoms, "the stent was necessary. His annual physical includes a stress test. EKG changes during the stress test yesterday prompted a CT angiogram, which confirmed a blockage that required opening."

A significant number of patients end up with stents after a routine physical, McPherson says. That's because some patients who experience occasional chest pain or shortness of breath may not tell anyone about their symptoms until a doctor asks.

Nissen said he's concerned about "overtesting" and overtreating people like Bush when they have no symptoms.

"He did a 100-kilometer bike ride," says Nissen, a feat that would be impossible for someone on the verge of a heart attack. "How can a stent make him better?"

People without symptoms also don't need annual stress tests, in which patients walk on a treadmill while doctors perform a test called an EKG, or electrocardiogram, Nissen says.

Bush likely "got the classical thing that happens to VIP patients, when they get so-called executive physicals and they get a lot of tests that aren't indicated. This is American medicine at its worst."

While it's possible to have a major artery blockage without symptoms, Nissen says that screening everyone with stress tests would end up doing more harm than good. That's because these screenings can lead to risky medical procedures that don't offer any proven benefit.

Still, McPherson notes that experts agree it makes sense to test certain professionals, such as school bus drivers and airline pilots, because a sudden heart attack on the job could cost many lives.

In a statement released Tuesday, the American College of Cardiology said it is important for people to be aware of their risk factors for heart disease, such as their cholesterol level, blood pressure, blood sugar levels and family history. One of the most important ways to reduce heart disease risk is to avoid tobacco.